The Heart

The Heart

A. Functions of the Heart

1. Generating blood pressure

Ø Required for blood flow through the blood vessels

2. Routing blood

Ø Two pumps, moving blood through the pulmonary and systemic

circulations

3. Regulating blood supply

Ø Adjusts blood flow by changing the rate and force of heart contractions as
needed

4. Ensuring One way blood flow

B. Size, Form, and location of the Heart

· Size: app size of a closed fist

· Form: Shaped like a blunt cone, with an apex and a base

Ø Apex: blunt rounded point of the heart

Directed anteriorly and slightly inferiorly

Ø Base: larger, flat part

Directed posteriorly and lightly superiorly

· Location: thoracic cavity between two pleural cavities that surrounds

the lungs

· 2/3 of the heart’s mass lies to the left of the midline of the sternum

· The heart is surrounded by its own cavity: Pericardial cavity

· Lies obliquely in the mediastinum

C. Anatomy of the Heart

· The heart consists of two atria and two ventricles

· Pericardium: a double-walled sac around the heart composed of

Ø A superficial fibrous pericardium

Ø A deep two-layer serous pericardium:

§ The parietal layer lines the internal surface of the fibrous pericardium

§ The visceral layer lines the surface of the heart

§ They are separated by the fluid-filled (pericardial fluid) pericardial cavity

External Anatomy

· Each atrium has a flap called an auricle

· The coronary sulcus separates the atria from the ventricles

Anterior Interventicular Sulcus

Posterior Interventicular Sulcus

· 6 large veins carry blood to the heart:

– SVC, IVC- Carry blood from the body to the R atrium

– 4 Pulmonary veins- carry blood from the lungs to the left atrium

· 2 arteries/ Great arteries/ Great Vessels- Carry blood away from the
ventricles of the heart

– Pulmonary trunk- 2 pulmonary arteries- carry blood to the lungs from

R ventricle

– Aorta- carries blood to the different parts of the body from the left
ventricle.

Heart Chambers and Internal Anatomy

· The interatrial septum separates the atria from each other

· The interventricular septum separates the ventricles

Atria

· Receiving chambers of the heart

· Each atrium has a protruding auricle

· Pectinate muscles mark atrial walls

· Veins entering the right atrium carry blood to the heart from the systemic
circulation

1. Inferior vena cava

2. Superior vena cava

3. Coronary sinus

· Veins entering the left atrium carry blood to the heart from the
pulmonary circulation

1. Four pulmonary veins

Ventricles
· Discharging chambers of the heart/ Pumping chambers of the heart

· Pulmonary trunk exits the right ventricle carrying blood to the pulmonary
circulation

· Aorta exits the left ventricle carrying blood to the systemic circulation

Heart valves

· Ensure unidirectional blood flow through the heart

· Atrioventricular (AV) valves lie between the atria and the

ventricles

· AV valves prevent backflow into the atria when ventricles contract

· Tricuspid valve: separates the right atrium and ventricle

. Bicuspid valve: separates the left atrium and ventricle

· Semilunar valves prevent backflow of blood into the ventricles

· Aortic semilunar valve: lies between the left ventricle and the
aorta
· Pulmonary semilunar valve: lies between the right ventricle and
pulmonary trunk

· Chordae tendineae anchor AV valves to papillary muscles

· Cardiac Skeleton: consist mainly of fibrous rings that surrounds the

atrioventricular and semilunar valves and give them solid support

Route of Blood Flow through the Heart

Blood Supply to the Heart

2 Coronary arteries branch off the aorta to supply the heart

o Left Coronary Artery: 3 branches:

Supply much of the anterior wall of the heart and most of the left
ventricle

– Anterior Interventricular Artery

– Circumflex Artery

– Left Marginal Artery

o Right Coronary Artery: 3 branches:

Supply most of the wall of the right ventricle

 – Posterior Interventricular Artery

– Right Marginal Artery

Blood returns from the heart tissues to the right atrium through
coronary sinus and cardiac veins

D. Histology of the Heart

Heart Wall

Ø The heart wall has three layers:

Epicardium

Ø Visceral layer of the serous pericardium (visceral pericardium)

Ø Provides protection against the friction of rubbing organs

Myocardium

Ø Cardiac muscle layer forming the bulk of the heart

Ø Responsible for contraction

Endocardium

Ø Endothelial layer over crisscrossing, interlacing layer of connective tissue

Ø Inner endocardium reduces the friction resulting from the passage of blood
through the heart

E. Electrical Activity of the Heart

Action Potentials

· After depolarization and partial repolarization, a plateau phase is

reached, during which the membrane potential only slowly repolarizes

· The opening and closing of voltage-gated ion channels produce the

action potential

· The movement of Na+ through Na+ channels causes depolarization

· During depolarization, K+ channels close and Ca2+ channels begin to
open

· Early repolarization results from closure of the Na+ channels and the
opening of some K+ channels

· The plateau exists because Ca2+ channels remain open

· The rapid phase of repolarization results from the closure of the

Ca2+ channels and the opening of many K+ channels

Refractory Periods

ØAbsolute refractory period

– Cardiac muscle cells are insensitive to further stimulation

ØRelative refractory period

– Stronger than normal stimulation can produce an action potential

· Cardiac muscle has a prolonged depolarization and thus a prolonged

absolute refractory period, which allows time for the cardiac muscle to relax
before the next action potential causes a contraction

Ø Autorhythmicity of Cardiac Muscle

· Some cardiac muscle cells are autorhythmic because of the

spontaneous development of a prepotential

· Prepotential: slowly developing local action potential

· The sinoatrial (SA) node is the pacemaker of the heart

· Collection of cardiac muscle cells capable of spontaneously generating

action potentials

· The prepotential results from the movement of Na+ and Ca2+ into the
SA node cells

· The duration of the prepotential determines heart rate

Conducting System of the Heart

· The sinoatrial (SA) node and the atrioventricular (AV) node are in the
right atrium

· The AV node is connected to the bundle branches in the

interventricular septum by the AV bundle

· The bundle branches give rise to Purkinje fibers, which supply the
ventricles

· The SA node initiates action potentials, which spread across the atria
and cause them to contract

ØSA node generates impulses about 75 times/minute

· Action potentials are slowed in the AV node, allowing the atria to

contract and blood to move into the ventricles

Ø AV node delays the impulse approximately 0.11 seconds

· Then the action potentials passes from atria to ventricles via the
atrioventricular bundle

· AV bundle splits into two pathways in the interventricular septum

(bundle branches)

· Bundle branches carry the impulse toward the apex of the heart

· Purkinje fibers carry the impulse to the heart apex and ventricular
walls
Electrocardiogram (ECG)

· Records only the electrical activities of the heart

· P wave corresponds to depolarization of the atria (SA node)

· QRS complex corresponds to ventricular depolarization

· T wave corresponds to ventricular repolarization

· PQ interval (PR interval) correspond to the time between the beginning

of P wave and the beginning of QRS complex

Ø During PQ interval atria contract and begin to relax

Ø End of PQ interval the ventricles begin to depolarize

· QT interval extends from the beginning of QRS complex to the end of

the T wave and represents the length of time required for ventricular
depolarization and repolarization.

· Based on the magnitude of the ECG waves and the time between waves,
ECGs can be used to diagnose heart abnormalities

F. Cardiac Cycle
· Repetitive contraction and relaxation of the heart chambers

Overview of Systole and Diastole

Ø Atrial systole is contraction of the atria

Ø Ventricular systole is contraction of the ventricles

Ø Atrial diastole is relaxation of the atria

Ø Ventricular diastole is relaxation of the ventricles

At the beginning of cardiac cycle

Ø Atria and Ventricles are relaxed

Ø AV valves open

Ø Semilunar valves are closed

Ø Blood returning to the heart enters atria first

Ø Blood flow into ventricles through open AV valves, filling 70%

approximately of their volume

Atrial Systole

Ø The atria contract, forcing additional blood to flow into the ventricles to
complete their filling. Semilunar Valves remained closed

Ventricular Systole

Ø At the beginning of ventricular systole, contraction of ventricles pushes

blood toward the atria, causing the AV valves to close as the pressure begins
to increase.

Ø As ventricular systole continues, the increasing pressure in the ventricles

exceeds the pressure in the pulmonary trunk and aorta, the semilunar valves
are forced open, and blood is ejected into the pulmonary trunk and aorta.

Ventricular Diastole

Ø At the beginning, the pressure in the ventricles decrease below the

pressure in the aorta and pulmonary trunk. The semilunar valves close and
prevent blood from flowing back into the ventricles.

Ø As diastole continues, pressure continues to decline in the ventricles until

the atrial pressures are greater than ventricular pressures. Then AV valves
open, blood flows directly from atria to the relaxed ventricles. During previous
ventricular systole, atria were relaxed and blood collected in them. When
ventricles relax and AV valves open, blood flows into ventricles and fill again

G. Heart Sounds

· Heart sounds (lub-dup) are associated with closing of heart valves

· First sound occurs as AV valves close and signifies beginning of systole

· Second sound occurs when SL valves close at the beginning of

ventricular diastole

· Murmurs are abnormal heart sounds as a result of faulty valves

G. Regulation of Heart Function

Ø CO is the product of heart rate (HR) and stroke volume (SV)

Ø HR is the number of heart beats per minute

Ø SV is the amount of blood pumped out by a ventricle with each beat

Ø CO (ml/min) = HR (72 beats/min) x SV (70 ml/beat)

Ø CO = 5040 ml/min (~5 L/min)

Ø Venous return is the amount of blood returning to the heart

Ø Increased venous return increases stroke volume by increasing end-

diastolic volume

Ø Increased force of contraction increases stroke volume by decreasing end-

systolic volume

Intrinsic Regulation

– Refers to mechanism contained within the heart itself

– Modifies stroke volume through the functional characteristics of cardiac

muscle cells
– Starling’s law of the heart describes the relationship between preload
and the stroke volume of the heart

– Preload is the degree to which the ventricular walls are stretched at the
end of the diastole

– An increased preload causes the cardiac muscle fibers to contract with a

greater force and produce a greater stroke volume

– Afterload is the pressure against which the ventricles must pump blood.

Extrinsic Regulation

– Modifies heart rate and stroke volume through nervous and hormonal
mechanisms

· The cardioregulatory center in the medulla oblongata regulates the

parasympathetic and sympathetic nervous control of the heart

· Epinephrine and norepinephrine are released into the blood from the
adrenal medulla as a result of sympathetic stimulation. They increase the rate
and force of heart contraction

– Parasympathetic stimulation is supplied by the vagus nerve

Ø Decreases heart rate.

Ø Postganglionic neurons secrete acetylcholine, which increases membrane

permeability to K. Hyperpolarization of the plasma membrane increases the
duration of the prepotential

– Sympathetic stimulation is supplied by the cardiac nerves

ØIncreases heart rate and the force of contraction (stroke volume)

ØPostganglionic neurons secrete norepinephrine, which increases membrane

permeability to Ca2+. Depolarization of the plasma membrane decreases the
duration of the prepotential

– Effect of Blood Pressure

ØBaroreceptors monitor blood pressure and the cardioregulatory center

modifies heart rate and stroke volume

ØIn response to a decrease in blood pressure, the baroreceptor reflexes

increase heart rate and stroke volume
ØWhen blood pressure increases, the baroreceptor reflexes decrease heart
rate and stroke volume

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